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A method for adjusting a malpositioned bifurcated aortic endograft

R I Rückert1, P Romaniuk, P Rogalla

  • 1Clinic of Surgery, Humboldt University Medical School (Charité), Berlin, Germany.

Journal of Endovascular Surgery : the Official Journal of the International Society for Endovascular Surgery
|October 7, 1998
PubMed
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A novel technique successfully repositioned a malpositioned bifurcated stent-graft during endovascular aortic aneurysm repair, restoring renal artery blood flow. This minimally invasive method offers a viable alternative to open surgery for graft adjustment.

Area of Science:

  • Vascular Surgery
  • Endovascular Repair
  • Medical Device Technology

Background:

  • Endovascular Aortic Aneurysm Repair (EVAR) is a common treatment for abdominal aortic aneurysms (AAA).
  • Malpositioning of bifurcated stent-grafts can lead to serious complications, including visceral artery occlusion.
  • Current methods for correcting malpositioned grafts may involve complex endovascular techniques or conversion to open surgery.

Observation:

  • A 62-year-old male patient undergoing EVAR for a 5.1-cm AAA experienced left renal artery occlusion after deployment of a Vanguard bifurcated stent-graft.
  • Intraoperative completion angiography confirmed the unexpected occlusion.
  • The patient's anatomy and the stent-graft position necessitated an immediate corrective maneuver.

Findings:

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  • A novel intra-aortic adjustment technique using a crossover guidewire successfully repositioned the malpositioned bifurcated stent-graft.
  • This maneuver effectively restored blood flow to the occluded left renal artery.
  • The patient remained well at 16 months postoperatively, with no evidence of endoleak, graft migration, or recurrent renal artery compromise.

    • Implications:

    • The demonstrated technique provides a minimally invasive option for correcting bifurcated stent-graft maldeployment during EVAR.
    • This approach can potentially avoid the need for conversion to open surgical repair.
    • This method may improve outcomes and reduce morbidity associated with EVAR procedures.